Flail Chest - an overview

One of the more interesting topics this term, the flail chest is a life threatening condition where the patient breaks two or more ribs. Anyway, I compiled some information and a video so here goes

A flail chest occurs when a segment of the chest wall breaks under extreme stress and becomes detached from the rest of the chest wall. It occurs when at least two ribs are broken in at least two places, so a part of the chest wall moves independently from the rest of it. The flail segment moves in the opposite direction as the rest of the chest wall: because of the ambient pressure in comparison to the pressure inside the lungs, it goes in while the rest of the chest is moving out, and vice versa. This so-called “paradoxical motion” can increase the work and pain involved in breathing. Studies have found that up to half of people with flail chest die. Flail chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation.

1. General information
1. Fracture of several ribs and resultant instability of the affected chest wall.
2. Chest wall is no longer able to provide the bony structure necessary to maintain adequate ventilation; consequently, the flail portion and underlying tissue move paradoxically (in opposition) to the rest of the chest cage and lungs.
3. The flail portion is sucked in on inspiration and bulges out on expiration.
4. Result is hypoxia, hypercarbia, and increased retained secretions.
5. Caused by trauma (sternal rib fracture with possible costochondral separations).

2. Medical management
1. Internal stabilization with a volume-cycled ventilator
2. Drug therapy (narcotics, sedatives)

3. Assessment findings
1. Severe dyspnea; rapid, shallow, grunty breathing; paradoxical chest motion
2. Cyanosis, possible neck vein distension, tachycardia, hypotension
3. Diagnostic tests
1. pO2 decreased
2. pCO2 elevated
3. pH decreased
4. Nursing interventions
1. Maintain an open airway: suction secretions/blood from nose, throat, mouth, and via endotracheal tube; note changes in amount, color, characteristics.
2. Monitor mechanical ventilation.
3. Encourage turning, coughing, and deep breathing.
4. Monitor for signs of shock.